Work

Distal femur osteosarcoma in an adolescent: Limb salvage with cryosurgery-recycled bone, hemi knee replacement, and ORIF—A case report

Year: 2025

Type: article

Abstract: This report presents a rare case of distal femoral osteosarcoma in an 11-year-old boy, managed through a hybrid limb-salvage approach combining cryosurgery-recycled bone, hemi knee arthroplasty, and internal fixation. The objective is to detail the surgical technique and assess short-term functional outcomes, particularly in adolescents with juxta-articular osteosarcoma. The patient presented with a three-month history of progressive right knee pain and swelling. Radiographs indicated classic osteosarcoma features, including a sunburst pattern and Codman's triangle. In the absence of biopsy and advanced imaging, diagnosis was made clinically and radiologically. Following 2 cycles of neoadjuvant chemotherapy, wide resection of the tumor was performed. The excised bone was treated with liquid nitrogen cryoablation and reimplanted as a recycled autograft. Knee joint reconstruction was completed using a cemented polyethylene hemiarthroplasty on the tibial side, with the femoral segment stabilized using a lateral locking plate. Postoperative recovery was smooth, with the patient achieving excellent functional outcomes within six months. No recurrence or metastasis was noted during follow-up. This case demonstrates the clinical feasibility of combining cryo-treated autograft and hemiarthroplasty for biologic limb reconstruction in pediatric patients. The technique preserves native anatomy, reduces donor site complications, and provides a cost-effective alternative to megaprostheses—making it particularly suitable for low-resource settings. Cryosurgery-recycled autograft combined with hemi knee replacement and internal fixation is a promising limb-salvage strategy offering favorable oncological and functional outcomes in managing pediatric osteosarcoma. • Demonstrates a unique limb salvage approach combining cryosurgery-recycled autograft, hemi knee arthroplasty, and internal fixation for pediatric distal femur osteosarcoma. • Offers a practical and affordable reconstructive option suitable for low-resource settings where megaprostheses may be inaccessible. • Shows excellent short-term functional recovery and absence of recurrence or metastasis at 6 months postoperatively.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.111957

Authors: Bangkit Primayudha, Muhamad Naseh Sajadi Budi, Wilson Wijaya, Mohammad Syarif Mas'ud

Institutions: Dr. Hasan Sadikin General Hospital, Padjadjaran University

Language: English

Topic: Sarcoma Diagnosis and Treatment

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090